Is substance use disorder more prevalent in patients with hidradenitis suppurativa?

Hidradenitis suppurativa associated telomere-methylome dysregulations in blood

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic debilitating disease with a significant burden of both organic and psychological comorbidities. It has been shown that certain telomere-related genes (TRGs) affect a wide range of diseases, including HS and its associated comorbidities, but their exact role in HS pathogenesis is still unknown.

OBJECTIVES

To determine whether TRG methylomes can be used as biomarkers in HS.

METHODS

Using the Illumina HumanMethylation450 BeadChip array, we examined methylation variations associated with TRGs in HS cases and age-, sex- and ethnicity-matched healthy controls. The study utilized integrated bioinformatics statistical methods, such as a false discovery rate (FDR), the area under the receiver operating characteristic curve (AUC) and principal component analysis.

RESULTS

There were a total of 585 different differentially methylated CpG sites identified in 585 TRGs associated with HS (474 hypomethylated and 111 hypermethylated) (FDR p-value < 0.05). A number of these CpGs have been identified as being involved in increased pain sensitivity including EPAS1, AHR, CSNK1D, DNMT1, IKBKAP, NOS3, PLCB1 and PRDM16 genes; GABRB3 as a potential alcohol addiction marker; DDB1, NSMCE2 and HNRNPA2B1 associated with cancers. Pathway analysis identified 67 statistically significant pathways, including DNA repair, telomere maintenance, mismatch repair and cell cycle control (p < 0.001).

CONCLUSION

The disruption of TRGs leads to the shortening of telomeres, which is associated with HS progression, ageing, cellular senescence and an increased risk of various diseases, including cancer and associated comorbidities, such as metabolic syndrome, cardiovascular disease and inflammatory disorders. Further research is necessary to better understand the underlying mechanisms and establish causal links between TRGs and HS. The present study is the first effort to comprehend potential pathomechanisms of sporadic HS cases concentrating on PBMC methylome since ours.

Hidradenitis suppurativa in sexual and gender minorities: A review and considerations for providers

The literature on hidradenitis suppurativa in sexual and gender minorities remains sparse. This review article aims to discuss critical factors for providers to consider in lesbian, gay, bisexual, transgender, queer, intersex, and asexual patients with hidradenitis suppurativa, including associated comorbidities, gender-affirming hormonal therapy, squamous cell carcinoma, infections in HIV-positive patients, and creating a welcoming clinic for sexual and gender minority patients.

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits

Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.

Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA

BACKGROUND

Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders.

OBJECTIVE

Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions.

METHODS

From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups.

RESULTS

A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others.

LIMITATIONS

Our study was limited by its retrospective design.

CONCLUSIONS

Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.

Hidradenitis suppurativa and psychiatric comorbidities, suicides and substance abuse: systematic review and meta-analysis

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the hair follicles, and has been associated with a multitude of systemic disorders and pathologies. There is increasing evidence to suggest that chronic inflammatory skin disorders may be associated with psychiatric comorbidities, however this relationship has not been well established. We aimed perform a systematic review and meta-analysis to assess the association between HS and psychiatric comorbidities, suicide and substance abuse.

Methods

A systematic review and meta-analysis was performed according to PRISMA guidelines.

Results

HS cases had a significantly higher odds of having schizophrenia compared to the control group (OR 1.66, 95% CI: 1.53–1.79, P<0.00001). There was also a significant association with bipolar disorders (OR 1.96,95% CI: 1.65–2.33, P<0.00001), depression (OR 1.75, 95% CI: 1.44–2.13, P<0.00001), anxiety (OR 1.71, 95% CI: 1.51–1.92, P<0.00001), and personality disorders (OR 1.50, 95% CI: 1.18–1.92, P=0.001), suicide (OR 2.08, 95% CI: 1.27–3.42, P=0.004), substance-related disorders (OR 2.84, 95% CI: 2.33–3.46, P<0.00001), and alcohol abuse (OR 1.94, 95% CI: 1.43–2.64, P<0.0001).

Conclusions

For dermatologists treating patients with HS, screening for these comorbidities, psychiatric referral and adequately managing pain will improve the overall wellbeing of patients.